Mayberg's research in neurology came about through observations that the psychological diagnoses of mental disorders was not aided by, or backed up by, neurological evidence—and that developing a system of mapping the circuitry of brain activity would allow for more objective diagnoses and treatment.[13][14][15]
Mayberg studies depression and integrates neuroimaging strategies such as Positron emission tomography (PET),[16] sMRI, fMRI, DTI, and EEG as well as behavioral and psychophysiological metrics to define brain mechanisms and testing of antidepressant treatments. She develops imaging biomarkers[17] and algorithms that discriminate patient subgroups and optimize treatment selection in the management of individual patients across all stages of illness. She also concentrates on testing deep brain stimulation for treatment resistant depression, bringing together electro physiologists, engineers, imaging scientists and clinicians to refine, optimize and extend the treatment of depression and other neuropsychiatric disorders.[18]
Since the 1990s, electric stimulation of parts of the brain have been used to treat Parkinsons. The origins of DBS date back to the 1930s.[19][20]
One deep brain stimulation treatment for depression, developed by Mayberg and colleagues, placed electrodes in the Broadmann area 25 of the brain in severely depressed patients. Initial results were encouraging, though clinical trials were deemed futile and ultimately halted; however, there were positive changes in the success rate of the trial after the trial was halted. As a result, she resumed research on her hypothesis.[7] Area 25 is connected to parts of the brain that are related to observable depression traits, such as appetite and sleeping habits. Her hypothesis is sometimes described as a pacemaker for the brain: electronic pulses that correct both the cause and the symptoms of depression.[21] Current research looks into why some patients respond to DBS and others do not.[22] To this end, a study led by Dr. Mayberg showed that brief intraoperative exposure to therapeutic stimulation at the time of implantation surgery induces rapid and consistent electrophysiological brain state change—indexed by a decrease in Beta wave measured at the site of stimulation. These intraoperative brain state changes are seen in individual subjects and are correlated with a significant and sustained reduction in depressive symptoms outside of the operating room without additional stimulation, establishing reduction in beta power as a novel biomarker for DBS treatment optimization.[23]
Psychophysiological Assessment of DBS Effects in TRD Phase II, Hope for Depression Research Foundation
Principal Investigator
$550,000
Predictors of Antidepressant Treatment Response: The Emory CIDAR, NIMH - P50 MH077083-01
Principal Investigator
$7,500,000
Multimodal Assessment of DBS Effects in TRD Phase I, Hope for Depression Research Foundation
Principal Investigator
$400,000
Related activities
Meditation and depression
In 2017, Mayberg and the 14th Dalai Lama of Tibet attended a conference on mindfulness and the impact of meditation on the brain. The Dalai Lama was interested in whether the brain impacts the mind or if it might be the other way around. Mayberg pointed out the impact of DBS on severely depressed individuals. Their informal hypothesis was that, based on experiments that examined brain behavior from people practicing meditation, and experiments involving DBS, it was likely that meditation could improve brain waves that are important to mental health — yet when a patient experiences a certain degree of depression, it takes biological treatment to restore the patient to where they can meditate at all.[24][25][26]
Neuroethics
One issue surrounding DBS is that it stands to change a patient’s identity or cause other undesirable emotional or biological conditions. The rebuttal is that severely depressed individuals often have lost a sense of self and that invasive procedures can block the barrier that might be the root cause of the loss of self, thereby restoring it.[27]
Mayberg gave a presentation in 2014 at the Presidential Commission for the Study of Bioethical Issues, where she expressed her clinical and experiential lessons in neuroethics. Her commentary focused on how severely depressed patients are rarely irrational, and that there needs to be open communication and a two-way understanding of expectations. She also asserted in publications that DBS patients should have their own words reflected in the medical literature.[28][29]
Neurolaw
Neurolaw, related to Neurocriminology, is based on the concept that MRI and PET scans as well as other means of examining of a person’s brain composition, can be used to hold harmless an alleged perpetrator in a court of law. Or, conversely, to justify a conviction. Adrian Raine was among those who postulated this theory in the 1980s, and it gained attention in the press after the trial and conviction of John Hinckley Jr.[30][31]
Other scholars, including Mayberg, have argued in editorials and interviews that science of the brain cannot be used, at least at this point, to offer evidence for a conviction. By extension, it could be erroneously interpreted that brain analyses could predict a person’s potential for criminal behavior.[32][33][34]
Mayberg, HS; Brannan, SK; Tekell, JL; Silva, JA; Mahurin, RK; McGinnis, S; Jerabek, PA (2000). "Regional metabolic effects of fluoxetine in major depression: serial changes and relationship to clinical response". Biol Psychiatry. 48 (8): 830–43. doi:10.1016/s0006-3223(00)01036-2. PMID11063978. S2CID634661. Citations: 961[43]
Thomas, M; Sing, H; Belenky, G; et al. (December 2000). "Neural basis of alertness and cognitive performance impairments during sleepiness. I. Effects of 24 h of sleep deprivation on waking human regional brain activity". J Sleep Res. 9 (4): 335–52. doi:10.1046/j.1365-2869.2000.00225.x. PMID11123521. S2CID35893889. Citations: 961[43]
References
^"Witness: Ex-soldier suffered from impulse control issues". NBC News. Paducah, Kentucky. 2009-05-12. Retrieved 2018-02-12. Ruben Gur, director of neuropsychology at the University of Pennsylvania School of Medicine, told jurors Tuesday that former Pfc. Steven Dale Green would be prone to acting inappropriately in chaotic situations because of the brain damage. Gur, testifying for the defense, said the brain damage likely was caused by several head injuries.
